静脉氟比洛芬酯联合吗啡单次硬膜外注射用于老年患者术后镇痛的效果

目的比较静脉氟比洛芬酯联合吗啡单次硬膜外注射与硬膜外自控镇痛（PCEA）用于老年患者术后临床镇痛效果和不良反应。方法选择ASA（美国麻醉师协会）分级Ⅰ～Ⅲ级,年龄65～80岁,全身麻醉联合硬膜外行腹部手术的患者40例,随机分为两组,实验组（静脉氟比洛芬酯联合吗啡组）术后予氟比洛芬酯100～150mg联合吗啡1mg硬膜外注射;对照组（硬膜外自控镇痛组,PCEA）应用硬膜外镇痛泵,吗啡0．05mg／mL复合罗哌卡因2mg／mL背景剂量2mL／h,PCEA单次剂量2mL／次。观察患者术后12h、24h、3611和48h作VAS评分和镇静评分,记录不良反应。结果两组患者术后的视觉模拟评分（VAS）评分和Ramsay镇静评分的比较,指标差异无统计学意义（P〉0．05）,两组患者术后不良反应发生情况的比较差异无统计学意义（P〉0．05）。结论静脉氟比洛芬酯联合吗啡单次硬膜外注射用于术后镇痛,可以产生良好的镇痛效果。与PCEA镇痛相比效果相当,不良反应无明显增加。     

不同浓度罗哌卡因复合舒芬太尼用于术后硬膜外镇痛效果比较

对50例择期行下腹部手术患者，采用随机双盲法分为五组，术后采用不同浓度罗哌卡因复合舒芬太尼硬膜外镇痛。罗哌卡因浓度为：A组0．10％，B组0．125％，C组0．15％，D组0．175％，E组0．20％，舒芬太尼浓度为0．5μg／ml。首次剂量5ml，设定持续输注背景剂量2ml／h。自控镇痛量每次0．5ml，锁定时间15min。分别于术后4、8、24、48h观察患者视觉模拟（VAS）评分、Bromage评分及副作用。结果A、B组VAS评分高于C组（P〈0．05、0．01），C组与D、E组比较．P均〉0．05；C组Bromage评分低于D、E组（P〈0．05、0．01）。副反应发生率D、E组多于C组．P〈0．05。提示0．15％罗哌卡因与舒芬太尼复合用于下腹部术后患者硬膜外镇痛中的镇痛效果确切，副作用少，适合临床推广。     

前列腺切除术后患者自控硬膜外镇痛防治膀胱痉挛

为观察患者自控硬膜外镇痛技术（PCEA）在前列腺切除术后膀胱痉挛防治中的效果，将60例行耻骨上经膀胱前列腺切除术患者术后按不同的解痉镇痛方法随机分为两组。观察组30例给予吗啡4mg、布比卡因150mg，生理盐水稀释成150ml，通过保留的硬膜外导管采用美国Baxter公司PCA－Ⅱ型自控镇痛泵持续给药，2ml/h。对照组30例给予杜冷丁50mg、阿托品0.5mg肌肉注射。所有患者均治疗3天，以疼痛视觉模拟评分法（VAS）间接评估镇痛效果，纪录膀胱痉挛次数、持续时间。结果术后膀胱痉挛发生率观察组为18％、对照组为83％（P＜0．01）；术后72小时内膀胱痉挛发生次数和持续时间观察组＜对照组（P＜0．01）；术后镇痛效果观察组好于对照组（P＜0．01）。认为PCEA能明显降低前列腺切除术后膀胱痉挛的频度和强度，镇痛效果优于其它方法。     

曲马多复合小剂量芬太尼在肺叶切除术后老年病人自控静脉和硬膜外镇痛中的应用

目的 观察比较在肺叶切除术后老年病人自控静脉和硬膜外镇痛中应用曲马多复合溶液的镇痛效果。方法 选择ASA Ⅰ-Ⅱ级的肺叶切除术老年患者40例，随机分为静脉自控镇痛组9静脉组）（芬太尼0.0003%＋曲马多1%＋氟哌利多0.005%）、硬膜外自控镇痛组（硬膜外组）（罗哌卡因0.1%＋芬太尼0.0001%＋曲马多0.3%＋氟哌利多0.002%）。镇痛泵均设置为背景剂量2ml/h，追加剂量0.5ml，锁定时间15min，手术结束前15min时给予负荷剂量5ml，开通镇痛泵。术后转入麻醉后监护室，呼吸室内空气，每隔2h观察记录术后血压、心率、脉搏氧饱和度、VAS疼痛评分、Ramsay镇静评分及镇痛并发症。结果 硬膜外组病人术后疼痛、镇静优于静脉组（P〈0.01），且静脉组有1例患者因过度频繁按压追加键而出现过度镇静状态；术后静脉组病人的收缩压、舒张压均明显增高（P〈0.01），第2天后才回落至术前水平（P〉0.05），心率则持续在较高水平（P〈0.01）；而硬膜外组血压、心率却有不同程度下降（P〈0.05）；两组间血压、心率相比较差异显著（P〈0.01）。两组均未发现低氧血症，静脉组并发症如恶心、呕吐、瘙痒、多汗、眩晕等较硬膜外组有增多的趋势，但无统计学意义。结论 用曲马多复合溶液可安全用于老年病人静脉或硬膜外自控镇痛，且硬膜外镇育、镇静效果更为理想。     

剖宫产术后镇痛对产妇血清泌乳素水平的影响

择期行硬膜外麻醉剖宫产分娩的足月初产妇60例，随机分为两组．各30例。实验组剖宫产术后接受患者自控硬膜外镇痛（PCEA），对照组术后不实施镇痛。放射免疫分析法测定两组术前及术后24、48h时的血清泌乳素（PRL），称婴儿出生时及出生后1～3d早晨的体质量，视觉模拟评分法（VAS）评价镇痛效果。术后24、48h实验组VAS评分明显低于对照组（P〈0．05）；术前两组PRL含量无差异，术后24、48h的PRL含量实验组明显高于对照组（P均〈0．01）；产后第3天实验组新生儿体重下降幅度低于对照组（P〈0．05）。表明剖宫产术后镇痛能减轻产妇疼痛，促进PRL分泌，有利于新生儿体质量的增加。     

瑞芬太尼静脉自控给药与腰硬联合阻滞用于分娩镇痛对比观察

将64例宫口开大3cm的自然分娩初产妇随机分为三组：瑞芬太尼静脉自控镇痛（PCIA）组（泵内配置50μg／ml瑞芬太尼）,瑞芬太尼负荷剂量0．5μg／kg自控给药;瑞芬太尼背景输注（BG＋PCIA）组,持续4ml／h瑞芬太尼输注;腰硬联合阻滞自控镇痛（PCEA）组,鞘内推注舒芬太尼5μg,硬膜外舒芬太尼及罗哌卡因联合自控镇痛。同期23例不要求镇痛的产妇为对照组。疼痛评分各镇痛组明显低于对照组（P均〈0．01）,PCIA组及BG＋PCIA组高于PCEA组（P〈0．01）;镇痛泵按压总次数PCIA组（78次）与BG＋PCIA组（50次）及PCEA组（5次）相比,P均〈0．05;镇痛满意度BG＋PCIA组及PCEA组均高于PCIA组（P均〈0．05）。PCEA组第2产程较其他组延长（P〈0．01）。各镇痛组无严重药物不良反应。认为静脉瑞芬太尼自控给药也可安全用于分娩镇痛。     

右美托咪定复合罗哌卡因自控硬膜外镇痛在孕足月产妇分娩中的应用

目的观察右美托咪定复合罗哌卡因自控硬膜外镇痛在足月待产妇分娩中的应用效果。方法60例足月待产妇随机分为复合组和单用组各30例。当产妇宫口开到2～3cm时,选择右侧卧位,L2-L3间隙直入法进针,穿刺成功后置入硬膜外导管,硬膜外腔内留置4cm,复合组注入负荷量0．5μg／kg右美托咪定5mL＋0．1％罗哌卡因10mL,单用组注入负荷量0．1％罗哌卡因10mL＋生理盐水5mL。产妇实行自控硬膜外镇痛,镇痛液的配置方法为50mg罗哌卡因＋生理盐水至50mL,镇痛泵设定为5mL／h、5mL／次,间隔时间15min。观察两组不同时点血压、心率、VAS评分、Ramsay镇静评分、运动神经阻滞评分、胎心、新生儿Apgar评分,记录产程及胎儿娩出后即刻脐动静脉血乳酸值。结果与单用组比较,复合组T1、T2时点VAS评分减少,Ramsay镇静评分增加（P均〈0．05）;余指标比较均无统计学差异。结论右美托咪定复合罗哌卡因自控硬膜外镇痛用于孕足月产妇分娩中镇痛、镇静效果较好,且对母婴无影响。     

不同浓度罗哌卡因和芬太尼用于腹部手术后硬膜外自控镇痛效果比较

目的探讨用罗哌卡因和芬太尼行腹部手术后硬膜外自控镇痛（PCEA）的最佳浓度。方法ASAⅠ-Ⅱ级下腹部以下手术患者350例,随机分为7组,各50例。所用镇痛剂A组为0.075%罗哌卡因＋3μg/ml芬太尼,B组为0.125%罗哌卡因＋3μg/ml芬太尼,C组为0.125%罗哌卡因＋4μg/ml芬太尼,D组0.2%罗哌卡因＋3μg/ml芬太尼,E组0.2%罗哌卡因＋4μg/ml芬太尼,F组为0.25%罗哌卡因＋3μg/ml芬太尼,G组为0.25%罗哌卡因＋4μg/ml芬太尼,配成100 ml药液。每组均加用恩丹西酮8 mg。负荷剂量为0.125%罗哌卡因＋芬太尼20μg/ml液6 ml,持续剂量为2 ml/h,PCA按压剂量为2 ml,锁定时间为15 min。结果A组VAS评分明显高于其他组（P均〈0.05）;E、F、G组VAS评分明显低于其他组（P均〈0.05）。A组患者按压次数或实际有效进药次数比值（D1/D2）〉5的比例高于其他组（P均〈0.05）。各组罗哌卡因和芬太尼用量无显著差异性（P均〈0.05）。镇静状态评分各组相比P均〈0.05。A、B、C三组运动阻滞评分相比P均〈0.05。D、E、F、G组运动阻滞评分与A、B、C组相比P均〈0．05。镇痛期间所有患者无呼吸抑制,但C、E、G组出现皮肤瘙痒、恶心呕吐和下肢麻木者较多。结论0．125％罗哌卡因＋3μg／ml芬太尼＋恩丹西酮8mg是腹部手术后PCEA的最佳浓度组合。     

小剂量氯胺酮术后镇痛对全髋关节置换术患者细胞因子表达的影响

目的观察小剂量氯胺酮＋芬太尼用于全髋关节置换术患者术后镇静、镇痛的效果,以及对细胞因子肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）的表达的影响。方法80例全髋关节置换术后患者随机分为两组行术后经静脉患者自控镇痛（PCIA）,F组（40例）配方芬太尼20μg／kg＋昂丹司琼8mg＋生理盐水至100ml;FI潍（40例）芬太尼16μg／kg＋氯胺酮2mg／kg＋昂丹司琼8mg＋生理盐水至100ml。术后静脉持续泵注2ml／h,观察不同时间点视觉模拟评分（VAS）镇痛、镇静、呼吸血压变化、恶心呕吐等不良反应,血清TNF-α和IL-1β的表达。结果两组患者术后各时间点VAS镇痛、镇静评分、平均动脉压、血氧饱和度比较差异无统计学意义（P〉0．05）;KF组患者与F组比较,术后恶心、呕吐不良反应明显减少（P〈0．05）;术后0及4hIL-1β的表达差异无统计学意义（P〉0．05）,术后12及24hIL-1βp表达明显降低（P〈0．05）;术后各时间点TNF-α的表达差异无统计学意义（P〉0．05）。结论小剂量氯胺酮复合芬太尼用于髋关节置换术患者术后镇痛,较传统的单用芬太尼术后静脉镇痛,能产生良好的镇痛效果,减少恶心、呕吐等不良反应,同时能抑制炎症因子IL-1β的表达,更有利于患者的康复。     

剖宫产术后三种镇痛方式的应用对比观察

目的对比观察剖宫产术后三种镇痛方式的镇痛效果,并观察对早期产后产妇血清泌乳素（PRL）水平的影响。方法剖宫产手术产妇150例,随机分为A、B、C组各50例。A组术后采用硬膜外镇痛泵,药物为芬太尼0.5 mg＋罗哌卡因250 mg;B组采用静脉镇痛泵,药物为芬太尼1.0 mg;C组采用哌替啶肌注镇痛。记录3组疼痛视觉模拟评分（VAS）、镇静评分、初乳时间、排气时间及恶心呕吐不良反应发生情况;采用放射免疫法检测产妇麻醉前和术后24、48 h的血清PRL。结果 A、B组的术后VAS、镇静评分、排气时间、初乳时间均优于C组（P均〈0.05）;A、B组术后24、48 h血清PRL水平高于C组（P均〈0.05）,A组术后恶心呕吐发生率低于B组（P均〈0.05）。结论硬膜外镇痛或静脉镇痛泵用于剖宫产术后镇痛效果优于哌替啶肌注,硬膜外联合应用小剂量罗哌卡因和芬太尼镇痛效果好,不良反应较轻,对产妇血清RPL水平影响小。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.